- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $5,549.00 / $11,100.08
| Facility | | $4,277.00 | $5,549.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,644.51 / $2,467.00 / $4,517.49
| Professional | | $1,644.51 | $2,467.00 | $4,517.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,559.41 / $4,156.57 / $6,608.00
| Facility | | $2,559.41 | $4,156.57 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,835.31 / $3,935.21 / $5,513.69
| Facility | | $2,835.31 | $3,935.21 | $5,513.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |